[Tumors of the appendix]. / Tumori na apendiksa.

Neoplasms involving the vermiform outgrowth are among the rarely met with conditions, accounting for 0.1 to 0.5 per cent of all gastrointestinal tract tumors. This is a report on personal observation of three patients presenting tumors of the appendix, diagnosed over the period 1987 to 1995. As shown by the results, tumors of the appendix run a clinical course characterized by two distinct forms: clinical picture of acute appendicitis--two cases, and clinical picture of tumor of the colon--one case. It is underscored that intraoperative diagnosis is extremely difficult. The diagnosis is usually made by pathoanatomist, while the therapeutic approach and operative tactics are determined on the ground of histomorphological study results and local operative status. The scope of operative intervention includes appendectomy and right hemicolectomy.

[Spontaneous internal biliary fistulae--a report of 4 clinical cases]. / Vurkhu spontannite vutreshni biliarni fistuli--s prinos na chetiri klinichni nabliudeniia.

This is a report on personal experience had with operative treatment of chronic calculous cholecystitis. Of the total of 228 patients operated on, spontaneous internal biliary fistulas are discovered in 4 cases (1.75 per cent): Mirizzi's syndrome--1 case. Fistula cholecystoduodenalis--3 cases. The development of fistulas is attributed to the elevated intrabladder pressure and activation of the infectious process and destructive changes taking place in the gallbladder wall, with ensuing breakdown and possibility of the concrement to penetrate an adjacent organ. It is presumed that pain localized in the right subcostal area and epigastrium is the symptom most strongly expressed. Cholecystocolonic fistula runs the heaviest clinical course among the patients operated on.

[Diverticula and pseudodiverticula of the gallbladder in chronic calculous cholecystitis]. / Divertikuli i psevdodivertikuli na zhluchniia mekhur pri khronichnite kalkulozni kholetsistiti.

The study covers twenty-two patients with chronic calculous cholecystitis (CCC) subjected to operative treatment. Diverticula are discovered in three of them (1.4 per cent), and pseudodiverticula of the gallbladder--in eighteen (8.2 per cent). In all patients presenting diverticula and pseudodiverticula of the gallbladder, the clinical course of the disease is typical of CCC, and in three it is characterized by the clinical picture of obstructive jaundice. Concrements are documented echographically in all cases. Intraoperatively, numerous adhesions, gallbladder kinking at infundibulum level with inflated gallbladder type "Hartmann's pouch" are established in all 18 patients presenting pseudodiverticula. Two of them have empyema of the gallbladder, and in one a colonic-vesical fistula is detected. All patients are subjected to operative management. The immediate postoperative and long-term results are estimated as very good.

[The combination of chronic calculous cholecystitis and diabetes mellitus]. / Za suchetanieto na khronichnite kalkulozni kholetsistiti s diabetes mellitus.

A total of 206 patients with chronic calculous cholecystitis (CCC) are subjected to operation in the surgical clinic of the Military Hospital--Plovdiv over the period 1991-1994 = Diabetes mellitus as a concomitant disease is discovered in 21 cases (10.20 per cent). All of them have pain syndrome complaints, and during cholecystectomy concrements in the gallbladder are found. As shown by the results, the combination CCC and DM leads to aggravation of the disease. Destructive changes in the gallbladder in this combination are detected in 28.5 per cent, whereas in patients free of DM they amount to 10.5 per cent. Presumably, removal of the gallbladder contributes to eliminate the persisting stress factor in terms of the insular apparatus of the pancreas. Assessment of the long-term results shows that the positive therapeutic effect of the operation is permanent.